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Resumen Objetivo Describir la técnica quirúrgica de reconstrucción del ligamento escafolunar asistida por artroscopia empleando como donante el extensor carpi radialis longus (ECRL), un músculo que, gracias a sus propiedades biomecánicas, puede ser muy ventajoso en este tipo de cirugía. Técnica Quirúrgica Tras artroscopia diagnóstica inicial según la técnica habitual, se llevó a cabo la reconstrucción ligamentosa empleando un hemitendón del ECRL mediante técnica mínimamente invasiva. Los dispositivos de fijación empleados fueron el SwiveLock para el escafoides y el tornillo de biotenodesis de 3 × 8 mm (Arthrex, Naples, FL, EE.UU.) para el semilunar. Complicaciones La complicación que puede surgir durante la realización de esta técnica es la extracción dificultosa de la plastia, por la intersección entre el primer y el segundo compartimentos extensores. Es fácilmente solventable realizando una incisión intermedia a nivel de la intersección para garantizar la adecuada liberación de la plastia a esta altura. Conclusión Es posible reconstruir el intervalo escafolunar empleando un hemitendón del ECRL, que, por propiedades biomecánicas, puede ser más ventajoso a la hora de restaurar la biomecánica del carpo. Se precisan estudios posteriores para confirmar la idoneidad y la superioridad de este donante frente a otros empleados en las técnicas de reconstrucción.

El objetivo de esteestudio fuecomparar lasrelaciones delasvirtudes personales, desde el enfoque de la psicología positiva, con la satisfacción con la vida de 129 adolescentes escolarizados en la ciudad de Alcorcón (Madrid), según el sexo y transcurrido un año tras el confinamiento provocado por la pandemia del COVID-19. Los instrumentos utilizados fueron dos cuestionarios, el Values in Action for Youth (VIA-Y, Park y Peterson, 2006) que mide las fortalezas humanas en adolescentes, y la escala de Satisfacción con lavida (SWLS), cuyo objetivo es evaluar los aspectos cognitivos del bienestar personal. El modelo usado para la medición es la versión en castellano de la SWLS de Diener, Emmons, Larsen, y Griffin (1985), escala que según Pavot, Diener, Colvin, y Sandvik, (1991) se puede utilizar con jóvenes y adultos. Los resultados del análisis de interdependenciaentre las variables mostraron relación entre la virtud de “templanza y capacidad de perdón” con la variable de satisfacción con la vida, no observándose significación en relación con la edad, ni el sexo de los participantes.

Messenger RNA vaccination against COVID-19 has been shown to produce an immune response with sufficient efficacy to prevent natural infection in immunocompetent recipients. However, the response in kidney transplant recipients is low. We aimed to evaluate the specific humoral response to SARS-CoV-2 after vaccination in a population of kidney transplant recipients and assess the main factors associated with a lack of response. We undertook a prospective study of 105 kidney transplant recipients and 11 recipients of a combined kidney-pancreas transplant. We analyzed immunoglobulin G and immunoglobulin M antibodies after the patients received their second and third doses of the messenger RNA 1273 (Moderna) or BNT162b1 (BionTECH-Pfizer) vaccinations between February and November 2021. Mean (SD) age of the 116 patients was 50 (16) years, and 65% were men. They had their transplants for 40 months (IQR, 15-123 months), with 14% undergoing retransplant and 11% sensitized. The maintenance immunosuppression regimen was steroids + tacrolimus + mycophenolate (MMF) in 68% of the patients and any combination with mammalian target of rapamycin inhibitor (mTORi) in 28%. A humoral response developed in 40% of the patients 6 weeks (IQR, 4-10 weeks) after receiving the second dose of the vaccine. Of the 67 patients with no response to the second dose, 51 had an analysis of the humoral response after the third dose, which was positive in 16 (31%). A total of 80% received the Moderna vaccine and 20% the BionTECH-Pfizer. No patient experienced major adverse effects after the vaccination. Factors associated with a lack of humoral response to the vaccine were recipient age (odds ratio [OR], 1.02; 95% CI, 1.001-1.05; P = .04), diabetes (OR, 2.8; 95% CI, 1.2-6.9; P = .02), and treatment with MMF (OR, 2.6; 95% CI, 1.08-6.8; P = .03). Treatment with mTORi was associated with a better response to vaccination (OR, 0.3; 95% CI, 0.1-0.9; P = .04). The humoral response to the COVID-19 vaccine in kidney transplant recipients is poor. Factors related with this lack of immunity are recipient age and diabetes, plus MMF therapy, whereas mTORi therapy was associated with a better response to vaccination.

Purpose Lumbar discogenic diffuse pain is still not understood. Authors describe the sinuvertebral nerve (SVN) as one possible cause. Body-donor studies are rare and controversial. Therefore, the aim was to revisit the origin, course and distribution in a body-donor study. Methods Six lumbar blocks (3 female, 3 male) aged between 59 and 94 years were dissected. After removal of the back muscles, lamina, dura mater and cauda equina, the anterior vertebral venous plexus, spinal artery and SVN were exposed and evaluated. Results 43 nerves out of 48 levels could be evaluated. The origin of the SVN was constituted by two roots: a somatic and a sympathetic branch arising from the rami communicantes. In 4/48 intervertebral canals studied (8.3%), we found two SVN at the same level. In 35/48 cases, one SVN was found. In 9/48 cases, no SVN was found. The SVN had a recurrent course below the inferior vertebral notch; in the vertebral canal it showed different patterns: ascending branch (31/43, 72.1%), common branch diverging into two branches (10/43, 23.3%), double ascending branch (1/43, 2.3%) finalizing two levels above and a descending branch (1/43, 2.3%). In 12/43 cases (27.9%) the SVN had ipsilateral connections with another SVN. The distribution ended in the middle of the vertebral body supplying adjacent structures. Conclusion A thorough understanding of the anatomy of the SVN might lead to significant benefits in therapy of discogenic low back pain. We suggest blocking the SVN at the level of the inferior vertebral notch of two adjacent segments. Level of evidence I Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding

There is a general agreement in all fields of sciences that practical pre-graduate education in human anatomy is absolutely necessary. It constitutes an inseparable partner with theoretical learning on the path to knowledge. As such is it critical to (1) establish the set of specific objectives for each practical session (PS), and (2) define more precisely the outcomes (i.e., knowledge, skills and attitudes) that are expected by students. The principle for efficiency of practical sessions (PSs) is that they should take place immediately after didactic sessions of the corresponding topic(s). In this way, students could best reinforce their learning. Considering that the morphology of the human body can be learned by means other than direct observation/dissection of anatomical donors, media, models and imaging have also gained popularity as “anatomy learning tools” in recent years. Imaging is a perfect complement for teaching in the dissecting room, but always in correlation with the reality of bodydonor sections, prosections and dissections of the same region. Anatomical models and computer programs express the reality of the human body, however, anatomical variations and many other qualities (i.e., surgical skills, ethics, pathology, professionalism) can only be appreciated via hands-on use of an anatomical donor to science. Therefore, the anatomical donor remains the Gold Standard for anatomy teaching, especially topographical Anatomy.

Introduction Morton's neuroma is an entrapment neuropathy of the third common plantar digital nerve, caused by the deep transverse metatarsal ligament (DTML). Minimally invasive or percutaneous surgery is a very common procedure, but surgical effectivity of this technique remains controversial. The goal of our study was to prove the effectiveness and safety of a new ultrasound‐guided technique for DTML‐release in a cadaver model. Materials, Methods, and Results The DTML was visualized in 10 fresh frozen donated body to science‐feet (eight male and two females, five left and five right) using an US device (GE Logic R7; 13 MHz linear probe, Madrid, Spain). Consecutively, minimally invasive ultrasound‐guided surgery was performed. Exclusion criteria of the donated bodies to science were previous history of forefoot surgery and space occupying mass lesions. The complete release of the ligament was achieved in all specimens without damage of any important anatomical structures as proven by anatomical dissection. Conclusions The results of this study indicate that our novel approach of an ultrasound‐guided release of the DTML is safer and more effective compared to blind techniques. The DTML could reliably be visualized and securely cut through a dorsal, minimally invasive surgical incision of only 2 mm.

Background The surgical procedure itself of lengthening the gastrocnemius muscle aponeurosis is performed to treat multiple musculoskeletal, neurological and metabolical pathologies related to a gastro-soleus unit contracture such as plantar fasciitis, Achilles tendinopathy, metatarsalgia, cerebral palsy, or diabetic foot ulcerations. Therefore, the aim of our research was to prove the effectiveness and safety of a new ultrasound-guided surgery-technique for the lengthening of the anterior gastrocnemius muscle aponeurosis, the “GIAR”- technique: the gastrocnemius-intramuscular aponeurosis release. Methods and results An ultrasound-guided surgical GIAR on ten fresh-frozen specimens (10 donors, 8 male, 2 females, 5 left and 5 right) was performed. Exclusion criteria of the donated bodies to science were BMI above 35 (impaired ultrasound echogenicity), signs of traumas in the ankle and crural region, a history of ankle or foot ischemic vascular disorder, surgery or space-occupying mass lesions. The surgical procedures were performed by two podiatric surgeons with more than 6 years of experience in ultrasound-guided procedures. The anterior gastrocnemius muscle aponeurosis was entirely transected in 10 over 10 specimens, with a mean portal length of 2 mm (± 1 mm). The mean gain at the ankle joint ROM after the GIAR was 7.9° (± 1.1°). No damages of important anatomical structures could be found. Conclusion Results of this study indicate that our novel ultrasound-guided surgery for the lengthening of the anterior gastrocnemius muscle aponeurosis (GIAR) might be an effective and safe procedure.

Objective The aim of this study is to describe in depth the precise anatomy of the vascular supply of the submandibular gland, trying to determine the existence of patterns of glandular vascularization. Knowledge of these patterns could facilitate surgical management of the gland and the submandibular gland flap. Material and methods Neck dissections of formaldehyde preserved human cadavers were performed. Submandibular and transmandibular approaches were used during the dissections. All the vascular branches found were registered and classified into 2groups: main or accessory branches. The anatomical data analyzed was: The diameter and length of the main and accessory branches, as well as the most important measurements of the submandibular gland flap pedicle. Results 33 glands were dissected to study the arterial supply of the submandibular gland (17 right, 16 left; 17 males, 16 females) and 29 were dissected to study the venous supply (15 left, 14 right; 15 males,14 females). A total of 123 arterial branches were found reaching the 33 submandibular glands (47 main and 76 accessories) and 116 venous branches were found draining the 29 submandibular glands (47 main branches and 69 accessory branches). A constant main venous branch that ran parallel to the Wharton duct and drained in the sublingual vein was found in all of cases (Concomitant Wharton Duct Vein or CWDV). Conclusion The CWDV is a constant venous branch for the drainage of the gland and should be considered as venous pedicle during the dissection of submandibular gland flaps.

BACKGROUND AND AIMS There is a high prevalence of sleep disorders in patients with CKD. Sleep apnea, restless legs syndrome and daytime sleepiness are much more common in haemodialysis patients than the general population. OBJECTIVE To know the prevalence of sleep problems in patients in our hospital haemodialysis unit through surveys carried out on patients. METHOD We designed a cross-sectional study on the prevalence of sleep disorders. Exclusion criteria age under 18 years. We gave 4 questionnaires to the patients in our unit: restless legs, Epworth daytime sleepiness, Berlin and Pittsburg Sleep quality. We collected demographic and clinical variables, dialysis parameters and laboratory data that could be related. Student's t-test and X-squared were applied for qualitative variables. SSps Version 15.0. RESULTS Of those surveyed, 12 had criteria for restless leg syndrome. The difference between ferritin and CRP among the RLS group was striking. Excessive daytime sleepiness is met in 10 patients. Only the CRP values were significantly higher in the group with the normal test. When associating the Epworth test and the Berlin questionnaire, we had a total of 3 patients with high risk of OSAS. 15 patients meet the criteria for poor quality of sleep in the Pittsburg questionnaire where we assess: quality, latency, efficacy and duration of sleep as well as use of medication and daytime impairment. CONCLUSION Highlight the high prevalence of sleep disorders: 24% restless leg syndrome, 20% daytime sleepiness and 30% with poor sleep quality. We must assess sleep disorders in haemodialysis patients since they present a significant deterioration in quality of life.

BACKGROUND AND AIMS Klotho is a transmembrane protein expressed mainly in distal tubular epithelial cells of the kidneys. Its gene expression and soluble form levels play a crucial role in the interaction of the aging-inflammation binomial and act as a co-receptor for the phosphaturic fibroblast growth factor 23 (FGF-23). Klotho deficiency, which is the norm in chronic kidney disease (CKD), has been reported as an independent risk factor for cardiovascular disease and subclinical atherosclerosis [1, 2]. This study investigates the evolution of Klotho and FGF-23 levels during the first 2 years after kidney transplantation and their variability depending on the glomerular filtration rate (GFR). METHOD Serum levels of Klotho and FGF-23 were determined in 42 patients right before kidney transplantation (KT) and at 3rd, 12th and 24th month after KT. The measurements were made by ELISA. The GFR of the kidney graft was performed by indirect methods (formula: MDRa and CKD-EPI) at each study visit. Variables were reported as mean ± SD, and a value of P < .05 was considered to be statistically significant for each test. RESULTS KT recipients were divided into two groups arbitrary: the first group with a GFR > 40 mL/min (n = 26) and the other one with a GFR ≤ 40 mL/min (n = 16). At the starting point, there was not found any statistical difference in Klotho and FGF-23 levels between groups (GFR > 40 mL/min: 462.65 ± 264.99 pg/mL and 786.84 ± 521.67 pg/mL, respectively; versus GFR ≤ 40 mL/min: 436.5 ± 189.33 and 779.02 ± 589.86). Those with better kidney function after KT significantly increased Klotho levels on 12th and 24th month of follow-up (baseline 462.65 ± 264.99 versus 12th month 561.96 ± 314.68 and 24th month 581.15 ± 350.10; P = .001), whereas KT recipients with a GFR ≤ 40 mL/min only proved an increase in Klotho levels at 12th month after a non-significant initial decrease at 3rd month (462 ± 204.91 versus 356.96 ± 177.07, respectively; P = .028). This trend was not confirmed at the 24th month (397.12 ± 182.05). Klotho levels were found significantly different at the 24th month between groups (P = .031). See Fig. 1. Figure 2 shows the changes in FGF-23 levels. There are significant differences in both groups from baseline to month 24. (P < .001 group GFR > 40 mL/min and P < .001 group GFR ≤ 40 mL/min). FGF-23 dropped significantly in both groups at the 3rd month (P = .018) and 12th months (P = .003). CONCLUSION Vascular disease and mineral metabolism malfunction are relevant abnormalities in patients with CKD as well as in KT recipients. This study shows that Klotho is increasingly produced after KT in those patients whose allografts achieve a better function. We failed to prove the same effect on those with a GFR

COVID-19 infection; Basiliximab; Renal transplantation Infección por COVID-19; Basiliximab; Trasplante renal Infecció per COVID-19; Basiliximab; Trasplantament renal Coronavirus disease 2019 (COVID-19) in kidney transplant recipients has a high risk of complications and mortality, especially in older recipients diagnosed during the early period after transplantation. Management of immunosuppression has been challenging during the pandemic. We investigated the impact of induction immunosuppression, either basiliximab or thymoglobulin, on the clinical evolution of kidney transplant recipients developing COVID-19 during the early period after transplantation. We included kidney transplant recipients with ˂6 months with a functioning graft diagnosed with COVID-19 from the initial pandemic outbreak (March 2020) until 31 July 2021 from different Spanish centres participating in a nationwide registry. A total of 127 patients from 17 Spanish centres developed COVID-19 during the first 6 months after transplantation; 73 (57.5%) received basiliximab and 54 (42.5%) thymoglobulin. Demographics were not different between groups but patients receiving thymoglobulin were more sensitized [calculated panel reactive antibodies (cPRAs) 32.7 ± 40.8% versus 5.6 ± 18.5%] and were more frequently retransplants (30% versus 4%). Recipients ˃65 years of age treated with thymoglobulin showed the highest rate of acute respiratory distress syndrome [64.7% versus 37.1% for older recipients receiving thymoglobulin and basiliximab (P < .05), respectively, and 23.7% and 18.9% for young recipients receiving basiliximab and thymoglobulin (P > .05)], respectively, and the poorest survival [mortality rate 64.7% and 42.9% for older recipients treated with thymoglobulin and basiliximab, respectively (P < .05) and 8.1% and 10.5% for young recipients treated with thymoglobulin and basiliximab (P > .05), respectively]. Older recipients treated with thymoglobulin showed the poorest survival in the Cox regression model adjusted for comorbidities. Thus thymoglobulin should be used with caution in older recipients during the present pandemic era.

Adalimumab dose escalation is often recommended for inflammatory bowel disease patients in case of loss of response. The usual adalimumab intensification regimen was 40 mg every week. Recently the original laboratory commercialized the 80mg injection pen. In the biosimilars era, this pen was sold at the same price as the 40mg pen. For this fact and for patient comfort, we proposed our stable intensificated adalimumab patients on a 40mg every-week regimen, to change dose to 80mg every-other-week.we designed an observational study to monitor outcomes through this posologic change. Clinical, analytic parameters and adalimumab trough levels were prospectively obtained at baseline, 4 and 12 months after posologic change. We describe the evolution of this cohort and calculate savings.13 patients were included. Median time of adalimumab intensification prior to posologic change to 80mg eow was 32 months (IQR 29-63). At 4 months all patients maintained adalimumab 80mg every-other-week. After month 4, two patients returned to the previous regimen after mild worsening, without significant changes in CRP, calprotectin or adalimumab-trough-levels. At 1 year adalimumab was stopped in one patient in remission with undetectable levels and positive adalimumab-antibodies. No significant differences in adalimumab-trough-levels were noted before and after the posologic change. Costs fell from 16276 €/patient/year of treatment to 8812.15 €/patient/year of treatment.in IBD patients with stable response to adalimumab intensification regimen of 40 mg every-week, changing to 80mg every-other-week seems to maintain response and similar adalimumab-trough-levels, and is cost-saving, although some patients may perceive mild symptoms.

espanolLas intervenciones basadas en Mindfulness son cada vez mas utilizadas en psicologia clinica por los efectos significativos que producen, siendo el sector de la tercera edad los principales candidatos de estas intervenciones, que enmarcadas en un modelo de envejecimiento con exito demandan una practica de calidad. Este estudio tiene como objeto el efecto de un programa de Mindfulness adaptado al ambito residencial, en una muestra de doce personas mayores, enfocado a mejorar el bienestar psicologico-emocional, percepcion de dolor, calidad y satisfaccion de vida, bajo un diseno cuasi-experimental pre-post test, dirigido a evaluar dichas caracteristicas; combinando practicas formales de atencion plena, con aspectos psico-educativos necesarios en el desarrollo de las mismas. Los resultados muetran efectos positivos en mas de la mitad de las areas intervinientes en el programa, siendo de interes para estudios futuros, utilizar una muestra mas amplia representativa de dicha poblacion con grupo de control, para seguir ahondando en formas de estimular el uso continuo de Mindulfulness en este colectivo EnglishMindfulness based interventions are increasingly used in clinical psychology because of the significant effects they produce, with the elderly being the main candidates for these interventions, which framed in a successful model of aging demand quality practice. The object of this study is the effect of a Mindfulness program adapted to the residential environment, in a sample of twelve elderly people, focused on improving psychological-emotional well-being, pain perception, quality and life satisfaction, under a quasi-experimental design pre-post test, aimed at evaluating these characteristics; combining formal practices of full attention, with psycho-educational aspects necessary in the development of them. The results showed positive effects in more than half of the areas involved in the program, being of interest for future studies, to use a larger sample representative of said population with control group, to continue delving into ways to stimulate the continuous use of Mindulfulness in this collective.

Mindfulness based interventions are increasingly used in clinical psychology because of the significant effects they produce, with the elderly being the main candidates for these interventions, which framed in a successful model of aging demand quality practice. The object of thisstudyistheeffect ofa Mindfulness program adapted to the residential environment, in a sample of twelve elderly people, focused on improving psychological-emotional well-being, pain perception, quality and life satisfaction, under a quasi-experimental design pre-post test, aimed at evaluating these characteristics; combining formal practices of full attention, with psycho-educational aspects necessary in the development of them. The results showed positive effects in more than half of the areas involved in the program, being of interest for future studies, to use a larger sample representative of said population with control group, to continue delving into ways to stimulate the continuous use of Mindulfulness in this collective.

Objectives: Lately, many countries have restricted or even banned transfat, and palm oil has become a preferred replacement for food manufacturers. Whether palm oil is potentially an unhealthy food mainly due to its high content of saturated Palmitic Acid (PA) is a matter of debate. The aim of this study was to test whether qualitative aspects of diet such as levels of PA and the fat source are risk factors for Metabolic Syndrome (MS) and Metabolic Associated Fatty Liver Disease (MAFLD). Methods: C57BL/6 male mice were fed for 14 weeks with three types of Western diet (WD): 1. LP-WD—low concentration of PA (main fat source—corn and soybean oils), 2. HP-WD—high concentration of PA (main fat source—palm oil), 3. HP-Trans-WD—high concentration of PA (mainly transfat). Results: All types of WD caused weight gain, adipocyte enlargement, hepatomegaly, lipid metabolism alterations, and steatohepatitis. Feeding with HP diets led to more prominent obesity, hypercholesterolemia, stronger hepatic injury, and fibrosis. Only the feeding with HP-Trans-WD resulted in glucose intolerance and elevation of serum transaminases. Brief withdrawal of WDs reversed MS and signs of MAFLD. However, mild hepatic inflammation was still detectable in HP groups. Conclusions: HP and HP-Trans-WD play a crucial role in the genesis of MS and MAFLD.

The possibility of transplanting a graft from a cadaveric donor with unknown membranous nephropathy (MN) has been described in the literature. We present the case of 2 patients who received their first kidney transplant (KT) from a 27-year-old male donor with no relevant medical history. The first recipient was a 50-year-old man with stage 5 chronic kidney disease secondary to diabetic kidney disease. Two biopsies were performed; the first was performed on day +9 because of impaired renal function coinciding with high levels of tacrolimus, and vacuolization of the arteriolar walls was observed with no other findings; the second was performed on day +13 because of creatinine stagnation, and methenamine silver staining showed multiple cavities and isolated spikes. Immunofluorescence revealed contiguous granular positivity in capillary walls for IgG and C4d, and immunohistochemistry showed contiguous parietal positivity for IgG4, compatible with donor membranous glomerulopathy. Anti-phospholipase-2 receptor (PLA2R) antibodies were negative. The second-year biopsy showed persistence of stage 1 MN, without proteinuria. The second recipient was a 38-year-old man with hypertension and unknown stage 5 chronic kidney disease who experienced immediate kidney function post-KT. In the protocol kidney biopsy 3 months post-KT, data consistent with stage 1 membranous glomerulopathy were also observed. Anti-PLA2R antibodies were negative, and proteinuria did not increase. The second-year protocol biopsy showed no MN data.

The atypical hemolytic-uremic syndrome (aHUS) is characterized by the triad of non-immune hemolytic anemia, thrombocytopenia, and acute renal failure. The aHUS is related to complement dysregulation; since the approval of eculizumab for this entity (a monoclonal antibody that inhibits C5 activation and blocks the formation of the membrane attack complex) the prognosis has improved. The recurrence of aHUS after kidney transplantation is frequent and implies loss of the graft in a high percentage of cases. Eculizumab prophylaxis to prevent recurrence has allowed successful kidney transplantation in this group of patients. We present a series of kidney transplant patients with chronic kidney disease secondary to aHUS and the use of eculizumab for prevention of recurrence.

Resumen: Introducción: El objetivo de nuestro trabajo es valorar si la estabilidad biomecánica que presenta la reconstrucción anatómica del ligamento talofibular anterior (LTFA) es similar a la que exhibe LTFA sano. Material y método: Realizamos un estudio biomecánico en cadáver con una muestra de 18 tobillos. Tras la aplicación de las maniobras de cajón anterior (CA) y estrés en varo (EV), medimos con un artrómetro, el movimiento angular en los tres planos espaciales (axial, coronal y sagital) registrado por un sensor localizado en el astrágalo. Resultados: Existen diferencias estadísticamente significativas en el plano axial entre el comportamiento biomecánico del LTFA intacto y del LTFA seccionado para la maniobra de CA con p = 0.012 y para la maniobra EV con p = 0.013. Por lo que respecta al plano coronal también objetivamos una diferencia estadísticamente significativa con la maniobra EV con p = 0.016. En el plano sagital no existen diferencias estadísticamente significativas con ninguna de las maniobras.Para finalizar, no existen diferencias estadísticamente significativas, si comparamos la reconstrucción anatómica con injerto del LTFA frente al LTFA intacto con ninguna de las maniobras. Conclusión: La reconstrucción anatómica con injerto del LTFA permite reproducir la estabilidad biomecánica del LTFA íntegro, en un modelo cadavérico a tiempo cero. Abstract: Introduction: The purpose of this work is perform a biomechanical comparison of anatomic reconstruction of the anterior talofibular ligament (ATFL) with the intact ATFL. Materials and methods: We studied 18 fresh cadaveric ankles with intact ATFL. Each specimen was clinically assessed with the anterior drawer (AD) and varus tilt (VT) tests and the angular movement in the three spatial planes (axial, coronal and sagittal) was measured with an arthrometer using a sensor located in the talus. Results: Statistically significant differences were found in the axial plane, between the intact ATFL versus the sectioned ATFL for AD test with p = 0.012, and for VT test with p = 0.013. Regarding the coronal plane, we also observed a statistically significant difference for VT test with p = 0.016. In the sagittal plane, there are no statistically significant differences in both maneuvers.No statistically significant differences were found when comparing the biomechanics of anatomic ligament reconstruction versus the intact ATFL. Conclusion: Autograft anatomic reconstruction of the ATFL showed biomechanical properties similar to those of the native ATFL, at the zero moment in a cadaveric model.

Background The frequency of appearance of anatomical variability in the terminal division of the popliteal artery (PA) is different according to the type of sample used, and ranges from 2% to 21%. The PA locates 1,01 cm behind to the lateral meniscus, which makes it vulnerable during surgical procedures. Iatrogenic injury of the PA or its terminal branches increases if anatomical variables are present. Our aim was to describe and review the branching pattern of the PA in a body-donors to science sample to determine the influence of the sample used (body-donors vs imaging test). Methods A sample consisting of 260 popliteal regions, corresponding to 130 corpses (66 women, 64 men), have been dissected. Multivariate analysis was carried out. Results The terminal division of the PA was classified as follows: Pattern 1: the PA divided into the anterior tibial (ATA) and the posterior tibial arteries (PTA) at the level or distal to the lower border of the popliteal muscle (PM) (94.7%). Pattern 2: the PA bifurcated into the ATA and PTA, proximal to the lower border of the PM (3.3%). Pattern 3: the PA divided at the same level into the ATA, PTA and PEA. (2%). No significant differences between gender and side of the limb could be find. Conclusions We propose a classification that encloses three identifiable groups only. This will allow clinicians to bear in mind these variables easily, at the same time avoiding injuries during surgical procedures such as lateral meniscus repair.

Clinical and diagnostic variations may occur due to the variable presence of a connection between the median and ulnar nerves in the forearm (Martin-Gruber anastomosis). This incidence has a wide range at 7%-40%. Most commonly, the connection between the nerves is considered to be composed of motor fibers; although, a sensory role has also been described. It is important to note that the number of axons, or the nature of the fibers in this connection, have not yet been elucidated. Fifty upper limbs were examined evaluating morphometric characteristics of the Martin Gruber connection, dissected out, sectioned, and immunohistochemically stained for choline acetyltransferase (ChAT) and analyzed with ImageJ© . The connection was observed in 32% of all cases (16/50). The nerve connections were identified as those in Pattern 1 group (12%-type 1b, 19%-type 1a, and 69%-type 1c) and contained motor (ChAT positive) fibers (40.42 ± 10.5% per connection) with three to four fascicles in each. No statistically significant differences were found according to sex, side, or laterality. There were statistically significant differences in the percentages of ChAT positive fibers; however, this was dependent on the distribution being greater in those not distributed zonally. The presence of this connection is prevalent in almost a third of the cadavers dissected; the understanding of this complex composition in sensory and motor fibers allows for the optimization of diagnosis and treatment of certain median-ulnar nerve injuries. Clin. Anat. 32:501-508, 2019. © 2019 Wiley Periodicals, Inc.

Background The aim of this study was to provide a safe ultrasound-guided minimally invasive surgical approach for a distal tarsal tunnel release concerning nerve entrapments. Methods and results The study was carried out on ten fresh-frozen feet. All of them have been examined by high-resolution ultrasound at the distal tarsal tunnel. The surgical approach has been marked throughout the course of the medial intermuscular septum (MIS, the lateral fascia of the abductor hallucis muscle). After the previous steps, nerve decompression was carried out through a MIS release through a 2.5 mm (± 0.5 mm) surgical portal. As a result, an effective release of the MIS has been obtained in all fresh-frozen feet. Conclusion The results of our anatomic study indicate that this novel ultrasound-guided minimally invasive surgical approach for the release of the MIS might be an effective, safe and quick decompression technique treating selected patients with a distal tarsal tunnel syndrome.

Introduction The purpose of this work is perform a biomechanical comparison of anatomic reconstruction of the anterior talofibular ligament (ATFL) with the intact ATFL. Materials and methods We studied 18 fresh cadaveric ankles with intact ATFL. Each specimen was clinically assessed with the anterior drawer (AD) and varus tilt (VT) tests and the angular movement in the three spatial planes (axial, coronal and sagittal) was measured with an arthrometer using a sensor located in the talus. Results Statistically significant differences were found in the axial plane, between the intact ATFL versus the sectioned ATFL for AD test with p = 0.012, and for VT test with p = 0.013. Regarding the coronal plane, we also observed a statistically significant difference for VT test with p = 0.016. In the sagittal plane, there are no statistically significant differences in both maneuvers. No statistically significant differences were found when comparing the biomechanics of anatomic ligament reconstruction versus the intact ATFL. Conclusion Autograft anatomic reconstruction of the ATFL showed biomechanical properties similar to those of the native ATFL, at the zero moment in a cadaveric model.

Aim To quantify the risk of dorsal innervation injury when performing direct metacarpophalangeal joint portals of the second to fifth fingers. Material and method An anatomical study of 11 upper limbs of fresh corpses was carried out. After placing them in a traction tower, the metacarpophalangeal portals were developed on both sides of the extensor tendon. The dorsal sensory branches were dissected, and the distances between the portal and the nearest nerve were measured by a digital calliper. The portals of all the fingers were compared globally to assess the safest finger, and two to two radial and ulnar portals were compared in each of the fingers to assess the safest portal within each finger. Results The overall comparison of all portals and fingers showed that the third finger is the safest in any of its portals, while the ulnar side of the second and radial of the fourth are the portals with the highest risk of nerve injury (P = 8.96 × 10−5). Comparison two to two of the radial and ulnar portals in each of the fingers showed that the ulnar portal is safer than the radial on the fourth finger (P = 0.042), while the radial is safer than the ulnar on the fifth finger (P = 0.003). Conclusions The third finger was the safest to perform metacarpophalangeal portals, while the ulnar side of the second finger and radial side of the fourth had the highest risk of nerve injury.

Resumen Objetivo Cuantificar el riesgo de lesion de la inervacion dorsal al realizar portales directos de la articulacion metacarpofalangica del segundo al quinto dedo. Material y metodo Se realizo un estudio anatomico de 11 extremidades superiores de cadaveres frescos. Tras colocarlos en torre de traccion, se realizaron los portales metacarpofalangicos a ambos lados del tendon extensor. Se disecaron las ramas sensitivas dorsales y se midieron las distancias entre el portal y el nervio mas cercano mediante un calibrador digital. Se compararon de forma global los portales de todos los dedos para valorar el dedo mas seguro y se compararon dos a dos los portales radial y ulnar en cada uno de los dedos, para valorar el portal mas seguro dentro de cada dedo. Resultados La comparacion global de todos los portales y dedos mostro que el tercer dedo es el mas seguro en cualquiera de sus portales, mientras que el lado ulnar del segundo y radial del cuarto son los que tienen riesgo mas alto de lesion nerviosa (p = 8,96 · 10-5). La comparacion dos a dos de los portales radial y ulnar en cada uno de los dedos mostro que el portal ulnar en mas seguro que el radial en el cuarto dedo (p = 0,042), mientras que el radial es mas seguro que el ulnar en el quinto dedo (p = 0,003). Conclusiones El tercer dedo fue el mas seguro para la realizacion de los portales metacarpofalangicos, mientras que el lado ulnar del segundo dedo y el lado radial del cuarto son los de mas alto riesgo de lesion nerviosa.

Resumen: La fibrilación auricular (FA) es un importante problema social y sanitario. Existe una amplia variación en la prevalencia de esta arritmia en los estudios que analizan a los pacientes en hemodiálisis (HD). Objetivo: Investigar la prevalencia, perfil clínico y manejo terapéutico de los pacientes con FA en HD en Andalucía. Métodos: Solicitamos al sistema sanitario público de Andalucía el número de pacientes que estaban siendo tratados con HD. Pedimos a los nefrólogos responsables de todos los centros hospitalarios y extrahospitalarios de 5 de las 8 provincias de Andalucía que realizaran un electrocardiograma y cumplimentaran un cuestionario en pacientes seleccionados por un muestreo aleatorizado simple. Resultados: Estaban en HD 2.348 pacientes en las 5 provincias incluidas. El tamaño muestral estimado fue 285 pacientes. Obtuvimos electrocardiograma e información de 252 (88,4%). Edad media 65,3 ± 16 años; 40,9% mujeres. Tenían FA 63 pacientes (25%). De estos, 36 (14,3%) tenían FA en el registro realizado y en el resto había sido documentada previamente. En el análisis multivariante, mayor edad (OR: 1,071; IC 95%: 1,036-1,107; p = 0,000) y mayor tiempo en HD (OR: 1,009; IC 95%:1,004-1,014; p = 0,000) se asociaron de forma independiente con la FA. De los pacientes con FA, el 41,3% estaban en tratamiento anticoagulante en el momento del estudio y el 41,2% con antiagregantes. Conclusiones: La FA en las unidades de diálisis es un importante hallazgo. Establecer la relación riesgo-beneficio del tratamiento anticoagulante constituye un auténtico reto. Son necesarios ensayos clínicos bien diseñados para establecer el uso racional del tratamiento antitrombótico. Abstract: Atrial fibrillation (AF) represents an important social and healthcare problem. There is wide variability in the prevalence of this arrhythmia in studies analysing patients on haemodialysis (HD). Objective: To investigate the prevalence, clinical profile and therapeutic management of patients with AF on HD in Andalusia. Methods: We asked the public healthcare system of Andalusia to provide us with the number of patients who were being treated with HD. We asked attending nephrologists from all hospital and outpatient centres in 5 of the 8 Andalusian provinces to perform an electrocardiogram and to fill out a questionnaire on patients selected by simple random sampling. Results: A total of 2,348 patients were being treated with HD in the 5 provinces included in the study. The estimated sample size was 285 patients. We obtained an electrocardiogram and information from 252 patients (88.4%); mean age 65.3 ± 16 years; 40.9% women. Sixty-three patients (25%) had AF. Of these, 36 (14.3%) had AF in the recorded ECG and in the rest it had been documented previously. In the multivariate analysis, older age (OR: 1.071; 95% CI: 1.036-1.107; P = 0.000) and greater time on HD (OR: 1.009; 95% CI: 1.004-1.014; P = 0.000) were independently associated with the presence of AF. Of the patients with AF, 41.3% were on anticoagulant treatment at the time of the study; and 41.2% were on antiplatelet agents. Conclusions: AF in dialysis units is an important finding. Establishing the risk-benefit ratio of anticoagulant treatment constitutes a real challenge. Well-designed clinical trials are pivotal in order to define the rational use of antithrombotic drugs. Palabras clave: Insuficiencia renal crónica terminal, Hemodiálisis, Fibrilación auricular, Tratamiento antitrombótico, Keywords: End-stage chronic kidney failure, Haemodialysis, Atrial fibrillation, Antithrombotic therapy

Background Because external laryngeal nerve (ELN) iatrogenic damage is frequent during neck surgery, its precise localization has been highly recommended. This study analyzes the different surgical landmarks previously proposed and the anatomy of the collateral and terminal branches of the ELN. Methods The necks of 157 (77 men and 80 women) human adult embalmed cadavers were examined. The ELN origin, length, and relationship to different landmarks were recorded and results statistically compared with those previously reported. Results The ELN is located deep to the ascending pharyngeal vein in 100% of patients. In most patients, it crosses the carotid axis at the thyroid artery origin level (47% of patients), passes medial to it (89% of patients), and shows an intramuscular trajectory through the inferior constrictor of the pharynx (80% of patients). Conclusion The ELN position, in relation to classical landmarks, is highly variable. The most reliable relationships are those with the ascending pharyngeal vein or with the superior thyroid artery.

There is no consensus about the role of the gubernaculum testis (GT). Nineteen human embryos (Carnegie stages 15-23), 36 fetuses (9 weeks to term), and eight neonates were examined. All the embryos and 25 fetuses (from weeks 9-16) were processed for paraffin wax histology and serially sectioned at 10 µm thickness. The remaining 11 fetuses and the eight neonates were fresh specimens that were dissected under a surgical microscope. The GT appeared during the embryonic period (stages 17-23) with a horseshoe-shaped mesenchyme condensation of the superior concavity, which was observed in four different topographical regions sequentially through development. The GT was not attached at either of its ends in any of the specimens, not to the gonad or in the scrotal sac. The inguinal canal differentiates around the inguinal portion of the GT during the late embryonic period. After stage 21, the GT appears enveloped by an evagination of the peritoneal cavity. It has few striate muscular fibers and vessels. Although the GT does not appear to have the role traditionally attributed to it, it is still an essential structure and indirectly facilitates the descent of the testes. It contributes to the formation of the inguinal canal and then forges the pathway that the testes will subsequently take through the inguinal canal as they migrate from the abdominal cavity into the scrotal sac. Clin. Anat. 30:599-607, 2017. © 2017 Wiley Periodicals, Inc.

Background The aim of this study is to provide a safe ultrasound-guided minimally invasive surgical approach for a proximal tarsal tunnel release concerning nerve entrapments. Methods and results The study was carried out on ten fresh-frozen feet. All of them were examined by high resolution ultrasound at the medial ankle region. The surgical approach was marked throughout the course of the flexor retinaculum (laciniate ligament). Once the previous steps were done, the flexor retinaculum release technique was carried out with a 2-mm entry only. As a result, an effective and safe release of the flexor retinaculum was obtained in all fresh-frozen feet. Conclusion The results of our anatomic study indicate that our novel ultrasound-guided minimally invasive surgical approach for the release of the flexor retinaculum might be an effective, safe and quick decompression technique treating selected patients with a proximal tarsal tunnel syndrome.

The masseteric nerve (MN) and the anterior branch of the obturator nerve (ON) that innervate the transferred gracilis muscle have proved highly efficient for reanimating paralyzed facial muscles when muscle transfer is required. Previous researchers have published the total axonal load for myelinated fibers in both nerves. However, the real motor axonal load has not been established. We performed the study on 20 MN and 13 ON. The segments of the MN and the ON were embedded in paraffin, sectioned at 10 μm, and stained following a standard immunohistochemical procedure using anti-choline acetyltransferase to visualize the motor fibers. The MN has a higher axonal load than the ON. There were statistically significant differences between the axonal load of the proximal segment of the MN and the ON. These findings confirm that end-to-end anastomoses between the MN and the ON should preferably use the proximal segment. However, MN neurotomy should ideally be performed between the proximal and distal segments, preserving innervation to the deep fascicles. Our results show that the MN is ideal as a donor motor nerve for reinnervating transplanted muscle for dynamic reanimation of the paralyzed face. The neurotomy should ideally be performed between the first and second collateral branches of the MN. Clin. Anat. 32:612-617, 2019. © 2019 Wiley Periodicals, Inc.

Objectives/Hypothesis It has been generally accepted that the branches of the internal branch of the superior laryngeal nerve to the interarytenoid muscle are exclusively sensory. However, some experimental studies have suggested that these branches may contain motor axons, and therefore that the interarytenoid muscle is supplied by both the superior and recurrent laryngeal nerves. The aim of this work was to determine whether motor axons to the interarytenoid muscles are present in both laryngeal nerves. Study Design Basic research. Methods Twelve human internal branches of the superior laryngeal nerve were dissected, and its branches to the interarytenoid muscle were removed and processed for choline-acetyltransferase immunohistochemistry, a method not used previously in studying the nerve fiber composition of the laryngeal nerves. Results The internal branch of the superior laryngeal nerve divided into two to five branches to the interarytenoid muscle. All branches contained motor axons, with the proportion of motor axons varying from 6% to 31%. Conclusion The present study confirms that the internal branch of the superior laryngeal nerve provides a motor innervation to the interarytenoid muscles. Level of Evidence N/A. Laryngoscope, 2015